Model for Innovation Exploration

Are generational differences in the workplace becoming a problem?

Steve Baker (writer at Business Week) at Blogspotting posted responses to such a question.  It’s an interesting thought worth further exploration.  Very interesting thoughts from the Twittersphere.

The tweets uncovered a gem of a story, too.  A gem that could provide a model for health care delivery innovation exploration.

Nick Eaton and seven of his young colleagues at the Spokane Spokesman-Review have been given the task by their editor (Steve) to “reinvent how a newspaper functions.”

We are charged to take a blank sheet of paper and come up with a way to make the Spokesman newsroom efficient while completing all if its objectives. The eight of us are meeting every day, often for several hours at a time, to work through this process.

A few guidelines and limitations have been laid out, but their remarkable task is fundamentally unpolluted.

Here’s the gist:

Our goal, as I understand it, is to come to Steve with a report by 5 p.m. July 10. He may or may not eventually implement our recommendations (we can have many), but he has promised to take them seriously.

Lots of work.  Lots of ideas I’m sure.  Very, very intriguing approach.

Interesting dialog:

There is skepticism and fear in the newsroom, of course. Many veteran Spokesman employees don’t like that Steve has selected eight young journalists and put some responsibility of the future of the newspaper into our hands. We don’t have the experience, they say. Steve sees it the opposite: We don’t have a stake in how newspapers have operated for 150 years, we don’t have a stake in who is in what editor position, we don’t really even have a stake in how the newsroom is currently structured.

Could a similar approach be used in health care?  Yes.  Could it be useful and productive and spark needed delivery innovation?  Yes.  It seems a perfect model for a hospital innovation center.

Organization Endeavor: “Journey of Learning”

Tom Peters summarizes a Wall Street Journal article saying “[t]here are, more or less, two flavors of companies”:

The first sort, focused on avoiding downsides, treats customers “only as data,” “manages risk through analysis,” “places big bets, slowly,” and frequently fails in new situations; alas, its rigidity and fearfulness increases through time in a vicious circle.

The second sort sees life as a “journey of learning.” It treats customers “as people”—and constantly seeks new input through direct contact with those customers. The Type Two group “places small bets, quickly” and manages risk through hustle and an abiding bias for test-try-adjust-action. It is relatively more successful in novel situations—which in turn creates a virtuous circle through which a “growth mindset” becomes the raison d’être of the firm itself.

My struggle: rationalizing why any health care organization, given the choice, would choose the former.  And my best reckoning indicates it most definitely is a choice.

It’s a brave new world requiring innovation, innovation, innovation (psst…innovation goes beyond new medical technology, new pharmaceuticals, and electronic medical record keeping).

Innovation is a continuous learning process that necessitates failure.  The key, however, is how the organization reacts to that failure.  Is it punished?  Or applauded and used as a tool for learning?  The answer to that question goes a long way to revealing the ideals of the organization.

Money quote from the article (article summarizes research by Sean Carr, Drs. Jeanne Liedtka, Robert Rosen, and Robert Wiltbank):

Indeed, interviews with the growth leaders revealed little frustration about the corporate hierarchy. Instead, they were experts at avoiding corporate interference as they executed their initiatives. They found supportive bosses who provided cover as they skirted restrictive budgeting processes, purchasing policies and hiring procedures.

The managers tended to ask for forgiveness afterward instead of permission before.

Aha! Rogue bandits get it done! Solution: people.  Put the people in place to make the organization willing to endeavor upon a “journey of learning.”

Asking Questions and Innovation in Practice

Lots of cool stuff going on at SSM St. Clare Health Center.

Namely, question asking:

Building from the ground up, SSM officials sought to streamline the health care delivery process through a facility that maximizes patient and practitioner efficiency. They started by turning inward, scrutinizing processes like outpatient admissions and emergency department procedures and soliciting opinions from staff, physicians and patients.

“It’s asking each one of us who deliver health care in today’s current state to really broaden our horizons, challenge the way we do things, ask ‘why’ a million times and then figure out what’s the right way,” said Brobst, a clinical director at St. Joseph.

YES!

And a commitment to delivery innovation:

Brobst oversees a unique 22-bed medical and surgical pilot unit that mimics conditions at the soon-to-open St. Clare. Housed in a medical office building connected to St. Joseph, the pilot unit allows nurses and physicians to implement new procedures and processes in real-world conditions.

The health system also spent more than $110,000 on a full-scale mock-up of a patient’s room at the new hospital. More than 150 St. Joseph employees have walked through the prototype in the last two years, providing feedback that resulted in changes ranging from the creation of individual nurse alcoves outside each room to wall-length safety bars leading from the bed to the bathroom.

YES!

Forward thinking hospitals. It’s cool to see good ideas in action.

New Perspectives Bring New Insight

Comarow on Quality has a post titled “What Medicine Can Learn from Business.” Waiting rooms (in which patients incur long waits) have long been a part of what we do.  But new perspecitives bring new insight. Mr. Comarow shares a story of Virginia Mason’s implementation of the Toyota Production System:

During the visit, a team led by Virginia Mason’s chief of medicine met with a Toyota guru, a sensei who had absorbed the Toyota approach into his very marrow. Examining a layout of the hospital, the sensei learned that there were waiting rooms scattered across the campus.

“Who waits there?” the sensei asked.

“Patients,” said the chief of medicine.

“What are they waiting for?”

“The doctor.”

The sensei was told there might be a hundred or so such waiting rooms and that patients wait about 45 minutes on average.

“You have a hundred waiting areas where patients wait an average of 45 minutes for a doctor?” He paused and let the question hang in the air. “Aren’t you ashamed?”

Allina to Build Innovation Center

The discoveries just keep getting better. First, this place earlier in the week. And now this press release from Allina in Minnesota:

Allina Hospitals & Clinics today announced it is creating a new, $100 million Center for Health Care Innovation to support innovations in both clinical and population health research that can be translated to improved health for patients and the wider community.

Areas of focus for the new Center include:

  • new models of care and coverage for populations currently underserved
  • investment in innovative community health initiatives
  • developing new approaches to care and disseminating that knowledge
  • supporting and expanding clinical research throughout Allina to improve patient care.

Not only is Allina making a concerted (and concentrated) effort at health care innovation, they are also working on improving the health of the communities they serve—a public health role that hospitals should be pursuing.

Speaking of Innovation…

More on innovation:

To examine the potential for change, BusinessWeek has joined with the Chicago-based innovation consulting firm Doblin (a member of consultancy Monitor Group). Larry Keeley, co-founder and president of Doblin, has pioneered a tool, Innovation Portraits, that reveals patterns of innovation in a specific industry. Of the many possibilities, we examine eight that are fermenting swiftly and hold high promise for transforming health care. They were chosen because of their intensity, measured by the number of innovations in a specific area, and their importance, determined by the impact the innovations could have on the practice of medicine.

The eight ideas all have something to do with delivery.  Although none of the ideas are new, few have been implemented well—or at all.  Opportunities abound.

Why the Aversion to Innovation?

Here is what is awful: rejecting retail health care because “a patient shouldn’t purchase health care at the same place they buy groceries/supplies/incidentals as the quality can’t be as good” or rejecting direct practice because “there is no way medical care can be delivered over the internet” or rejecting medical tourism because “there is no way that a consequential number of Americans will ever want to receive care overseas.”

Rejection because “it’s something new” is awful.

For whatever reason (precedent mostly), the health care industry is averse to new ways of doing things. If a new way of performing a task is accepted, it is definitely not without significant debate—and even then it’s not implemented everywhere.

We need a lot of things to happen to get us out of our health care mess. In traditional health care organizations, innovation needs to start at finding new and better ways to deliver care.

Why do we have such an aversion to innovation in health care?  And how do we go about changing that?

Here are some thoughts and possibilities (feel to add/subtract as you feel necessary, but only if your argument sounds nothing like the first paragraph of this post):

1. Let your patients participate in design. Really, ask them what they want. Ask them to design around their needs. As Max Chafkin in this INC. article writes, “The companies that win will be the ones that listen.” What does that mean? Focus groups. Interviews. Questionnaires. “Overhearing” conversations in the hallways or in the cafeteria. Blog. Twitter. Facebook. It sounds crazy, but “user innovation” is possible. From the same article:

This idea goes against a basic principle that has been taught in business schools since the invention of mass production: Employees make stuff, and customers buy it. But this notion seems anachronistic in a marketplace of ever-narrowing niches and nearly unlimited consumer choices. Meanwhile, a generation of so-called Web 2.0 companies has succeeded by encouraging customers to contribute to, and in some cases create, the product being sold. Not only do we have instantaneous access to countless television programs though video websites, but anyone with a YouTube account and a digital camera can create a show of his or her own. Professionally edited, dead-tree newspapers are besieged by digital news sites that are produced and edited by their readers. The 240-year-old Encyclopaedia Britannica finds itself eclipsed — at least in terms of readership — by Wikipedia.com, which pays its writers nothing and requires that they possess no expertise at all.

2. Create a department that !only! pursues delivery innovations. Kaiser Permanente’s Sidney R. Garfield Innovation Center “is a living laboratory where ideas are tested and solutions are developed in a hands-on, mocked-up clinical environment. Many aspects of delivering healthcare can be innovated and examined at the Center using real-world scenarios and activities, such as simulations, technology testing, prototyping, product evaluations, and training.”

It’s important to have a centralized figure collecting ideas and making the necessary connections that turn an invention into innovation. Ram Charan says in a Fast Company interview:

Let me explain some simple things. First, as Thomas Edison said, an idea is called invention. Converting an idea into revenues and profits or something a customer uses is innovation. Today, in the Internet society, you can buy ideas. You can have ideas flow to you from outside your department and outside your company. Innovation is selecting an idea and converting it to the production of a product, service, or new business model that creates growth and profit. The conversion of an idea for most companies, if not all, requires more than one person to make it happen. And that is why it is a social process.

And sums up his thoughts like this:

Necessity is the mother of invention. Those companies that are not getting top line growth organically, they are absolutely pressed to figure out how to create these collaborative changes for innovation. This is the era of the renaissance of innovation. If you don’t do innovation, cost cutting is not enough. You will be left behind.

3. Stop waiting on the government. CMS regulations handed down (and then copied by private insurers) are ruthlessly tearing through your organization. Preventing hospital acquired infections should have been a top priority before payers stopped paying for them. As we all know CMS is constantly looking for reasons not to pay your organization. Why not make it about constant improvement instead of constant reaction?

4. Waiting to hear from you…

I know we’ll figure it out. Crisis produces innovation. But wouldn’t you rather make a proactive decision?

Will any of this work? I’m sure of it. Will all of it work? Not likely. But here is the message: continuing to criticize delivery innovations as pie-in-the-sky developments is dangerous. It’s even more dangerous to stand by and do nothing. Let us be p-r-o-a-c-t-i-v-e, I’m begging…

Twitter and Health Care

Do you know what Twitter is? (Here, read this if your answer was anything but a confident YES!)

I wish I could describe what Twitter will mean to health care, especially to health care organizations.  But I can’t. Because I don’t know.  But I have a hunch it is going to do something for health care.

So it seems appropriate for all of us to take notice of Tech Soup’s non-profit Twitter event today:

Join new media consultant and blogger, Marshall Kirkpatrick and Michaela Guerin Hackner, Director of Online Strategy at World Learning, as they dive deeper into how and why to use Twitter to benefit your nonprofit. We’ll look at more complex ways Twitter can be incorporated into your marketing strategy, help with professional development, and build your community of supporters. This is a great chance to discuss ask any further questions you have of our expert event hosts.

Here’s the link for the event.

Here’s my Twitter feed.

Health Care Innovation Center!

Kaiser Permanente’s Sidney R. Garfield Innovation Center “is a living laboratory where ideas are tested and solutions are developed in a hands-on, mocked-up clinical environment. Many aspects of delivering healthcare can be innovated and examined at the Center using real-world scenarios and activities, such as simulations, technology testing, prototyping, product evaluations, and training.”

From an ADVANCE article:

“The center’s focus is to get front-line staff — the people who are delivering care — to come together and work with designers, architects and technologists to innovate or improve a physical space, a new technology or some type of work process,” explained Jennifer Ruzek, director of the center. “It’s really important that all the disciplines work together, because if you want to improve a complex process such as medication administration, nursing, pharmacy and physicians all need to come together.”

This is cool on multiple accounts—an organization has taken health care delivery innovation so seriously that they have created a center to facilitate continuous improvement.  The benefits:

“You can get large groups of people from different disciplines together, speaking the same language experientially, to reach consensus on what is the best design that meets their needs and the patients’ needs,” Ruzek said. “We’ve found that when you take people out of their day-to-day environment, a few things happen: First, they’re not distracted by what’s going on in a live facility. People begin to step back and think about the big picture. Nurses, as you know, are great at working around challenges. But here, you’re asking them to think differently — they come up with ideas that solve challenges, rather than just working around them.

“Second, we’ve found the experimental prototyping process at the Garfield Center speeds up decision-making. We rule out ideas that don’t work quickly and arrive at solutions faster.

“And third, it’s much easier to try out ideas in a mock environment rather than disrupting a real hospital unit or clinic.”

This makes so much sense, why are there not more organization sponsored dedicated environments to explore delivery innovations?

Redefining the Hospital (one step at a time)

Tomorrow’s Today’s health care organizations need to offer more services than what have been traditionally offered.

Services that, today, are not necessarily revenue positive—some call them mission-based. (Right now) It’s about making the people in the communities those organizations serve healthier.  From the Duluth News Tribune:

The record player speaker crackles with big band tunes as exercises commence.

Every Tuesday and Friday morning, 12 seniors stop by to practice a series of exercises — from volleying balloons to holding up their feet while sitting — designed to strengthen muscles that help them balance.

Most say they definitely have seen results.

“I had some bad falls,” said Ted Barker, 85, of Duluth. Since joining the year-old class, the lanky man’s gait is straight and steady, and he hasn’t fallen.

“I feel I’m much better off,” Barker said. “This is a great thing.”

The class is part of a grander shift at the clinic to become more patient-friendly.

So we all know the problem that arises when health care providers offer non-traditional services that help people: they don’t get paid.  Making the business case on an individual level to individual patients can be helpful individually—but that possibility does little to improve the health of the community as a whole (not to mention producing negligible results in the cost-savings department).

The physician’s focus may be at an individual level—that’s fine.  The organization’s (hospitals, clinics, etc.) focus must be both individual and collective.  It’s just that our system necessitates an organization prove a service’s efficacy in order to be considered reimbursable.  Wait, it does?